Isolated paracetamol-induced acute kidney injury: a systematic review

Abstract

Aim: We sought to characterise the syndrome of isolated paracetamol-induced acute kidney injury (AKI), whose incidence and mechanisms are poorly understood. Methods: Using systematic review methodology, fifty-six papers relating to paracetamol-induced AKI were identified. Results: 24 cases of isolated paracetamol-induced AKI were identified and compared to 87 identified cases of concurrent renal and hepatic injury. Paracetamol-induced AKI became detectable 3-4 days after exposure; liver injury, where it occurred, preceded AKI detection by 1 day. Risk factors affecting hepatotoxicity risk do not appear to influence isolated AKI, with no clear associated factors except younger age (mean 18.8 versus 33.1 years). Conclusions: Isolated paracetamol-induced AKI appears commoner in younger patients. Paracetamol-induced AKI occurs late and may go undetected by current treatment guidelines.

Paracetamol overdose causing acute kidney injury without hepatotoxicity: a case report

“…The incidence of isolated acute kidney injury (AKI) is unclear. It is very rare, ranging from 0.4 to 1.25% [ 2 ]. Many studies have demonstrated that large doses of paracetamol can cause kidney injury in rodent models [ 4 ].…”

“…AKI with paracetamol overdose is more common in adolescents and young adults, but the reason is unclear [ 6 ]. Isolated AKI has been observed to occur with an average age of 18.8 years [ 2 ]. An explanation could be that endoplasmic reticulum stress decreases with age.…”

“…Paracetamol intake has a higher risk of toxicity in patients who consume alcohol, in case of starvation or fasting, and in persons who take medications that induce the P-450 microsomal oxidase enzyme [ 5 , 6 ]. Isolated AKI, in contrast to combined hepatotoxicity and nephrotoxicity, appears to occur when a lower dose of paracetamol is ingested [ 2 ]. Our patient was young, took a small dose of paracetamol (10 g), and had none of these risk factors.…”

“…Hepatotoxicity is more common than nephrotoxicity. Acute kidney injury (AKI) can occur even in the absence of liver failure, but is a very rare and little-known event [ 2 ]. For this reason, we decided to present this case of a 15-year-old girl who presented with acute kidney injury due to paracetamol overdose, without hepatotoxicity.…”